Presenting complaints and emergency triage priority of older adults hospitalized with delirium: a retrospective cohort study.

PURPOSE: To determine triage allocation in older adults hospitalized with delirium and identify factors associated with lower triage priority.

METHODS

Retrospective cohort study including patients aged ≥ 65 years admitted with delirium to geriatric acute care units. Triage was performed using the Swiss Emergency Triage Scale (SETS, levels 1–4). Patients assigned to levels 3–4 (low priority) were compared with those at levels 1–2 (high priority). Multivariable logistic regression identified predictors of lower priority triage.

RESULTS

Among 2889 patients with delirium (mean age 85 years; 54.7% female), 59.8% were triaged at SETS 1–2 (high priority) and 40.2% at SETS 3–4 (low priority). Lower-priority triage was driven by nonspecific presentations such as general decline (18.9%) and falls (11.6%), while dyspnea (28.1%) and acute neurological deficits (11%) were strongly associated with higher priority. Independent predictors of SETS 3–4 included higher functional independence (FIM, OR 1.01 per point, p < 0.001), dementia (OR 1.39, p = 0.001), psychiatric comorbidity (OR 1.31, p = 0.007), and higher pain scores (VAS, OR 1.04 per point, p = 0.027). Conversely, acute respiratory failure (OR 0.25, p < 0.001), acute heart failure (OR 0.66, p < 0.001), pulmonary embolism (OR 0.51, p = 0.017), pneumonia (OR 0.82, p = 0.038), other hypoxia-related conditions (OR 0.63, p = 0.007), higher leukocyte count (OR 0.98, p = 0.026), and psychotropic exposure (OR 0.83, p = 0.030) were associated with decreased odds of lower-priority assignment.

CONCLUSION

Standard emergency triage may underrecognize the clinical risk of delirium in older adults, particularly when presentations are nonspecific and cognitive or psychiatric comorbidities are present.